Fillable Credit Bureau Dispute Form printable pdf download

Credit Bureau Dispute Form

Download a blank fillable Credit Bureau Dispute Form in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Credit Bureau Dispute Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

CREDIT BUREAU DISPUTE FORM

Member FDIC

***Please complete this form in its entirety***

Full Name:

Social Security Number:

Address:

Date of Birth:

City:

Home Phone:

State

Zip:

Mobile/Cell Phone:

E-mail:

Work Phone:

First

Bank reports to the following credit bureaus listed below. Please mark

you are disputing:

Equifax

Experian

Innovis

TransUnion

_______________________________

**PLEASE PROVIDE A COPY OF THE CREDIT REPORT THAT SUPPORTS YOUR DISPUTE.**

Account number(s) as listed on credit report that are being disputed: ________________________________________

Please check the appropriate box(es) which describes the information you believe to be incorrect:

BALANCE:

Reported as $________________ Should Be $________________

Account Paid Off

Explanation:

PAYMENT:

Not Reported

Not Past Due

Last Payment Date

Include proof of payment. (Example: Copies of Cancelled Checks; Account Statement)

Explanation:

CREDIT STATUS INCORRECT:

Reported as ________________ Should Be________________

Not my Loan

Other:

**If your dispute is based on possible fraud, please provide a copy of your driver's license & social security card.

The statements I have made on this request are true and accurate to the best of my knowledge.

Signature:

Date:

Return this form and the supporting documents to:

First Midwest Bank

Attn: Credit Dispute Department

704 N. Westwood Blvd

Fax:

573 785-8253

P O Box 160

Poplar Bluff, MO 63901

Date Received:

Date Investigation Completed:

Received By:

Investigation Completed By:

Print Form

Credit Bureau Dispute Form

Related Articles

Related forms

Related Categories